Active surveillance for prostate cancer: Is it ready for primetime in the Caribbean?

Comparison of Characteristics, Follow-up and Outcomes of Active Surveillance for Prostate Cancer According to Ethnicity in the GAP3 Global Consortium Database

“…In the USA, African-American men are 1.6 times more likely to develop prostate cancer (PCa) and twice as likely to die from the disease as the general population [1] . Similar incidence and mortality patterns are seen elsewhere, particularly among West African descendants, including in the UK and the Caribbean [2] , [3] . Men of African descent may also develop more aggressive disease [4] , [5] , [6] and be at a greater risk of disease progression after curative treatment [7] .…”

“…Censoring occurred at the time of death, switch to watchful waiting (ie, no active monitoring with noncurative treatment if symptoms arise), loss to follow-up, or the last follow-up date if still on AS. Models were adjusted for age (5-yr age groups), diagnostic period (1995–2004, 2005–2009, 2010–2014, and 2015–2018), diagnostic method (transrectal ultrasound guided biopsies, transperineal guided biopsies [TPs], and transurethral resection of the prostate [TURP]), and clinical characteristics at diagnosis—grade group (2 vs 1), clinical stage (T2 vs T1), PSA concentration (<5, 5–9.9, 10–14.9, and 15–20 ng/ml), prostate volume (continuous per 10 ng/cc [3] ), number of cores sampled (continuous), and number of positive cores (continuous). We assessed the risk of upgrading at any follow-up biopsy and the risk of potential disease progression among men who had undergone one or more repeat biopsies, using mixed-effects logistic regression, with random intercepts for treatment centre (level 2).…”

A Review of Localized Prostate Cancer: An African Perspective

“…There is sufficient evidence to suggest that active surveillance is feasible for indolent localized prostate cancer, but data have shown that black men do not show satisfactory outcomes with active surveillance compared to their white counterparts due to the aggressive nature of the disease in blacks [30]. A retrospective study of 379 Ghanaian men undergoing radiotherapy for prostate cancer revealed that 34.6% of patients with localized prostate cancer received either external beam radiation or brachytherapy [26].…”

The current state of prostate cancer treatment in Trinidad and Tobago

“…The aim of active surveillance is to avoid the overtreatment of clinically insignificant cancers and with it the adverse effects of prostate cancer treatment. There is concern about the application of active surveillance to men of African descent and it is therefore still unclear whether active surveillance is a safe option for our Caribbean men [ 15 ]. Active surveillance is an option to patients throughout the country although there is no uniformity and protocols are at the judgment of the treating urologist.…”